Eclampsia: Difference between revisions

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== Background ==
==Background==
*Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
*[[Preeclampsia]] and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
**May occur sooner w/ gestational trophoblastic disease
**May occur sooner with gestational trophoblastic disease
*Suspect in any pregnant pt who is >20wk or <4wk postpartum who develops seizures
*Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures


==Treatment==
==Differential Diagnosis==
#Delivery
''[[Preeclampsia]]''
#Seizure Tx
 
##Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr
{{Seizure DDX}}
###Can give up to 10gm IM
 
###Observe for loss of reflexes, respiratory depression
{{Postpartum emergencies DDX}}
###Must adjust dose in pts w/ renal failure
 
##If seizures recur:
==Management==
###Consider other anticonvulsant drugs
#[[Delivery]]
###Consider alternative diagnosis
#Seizure treatment
#*[[Magnesium]]: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
#**Can give up to 10 gm IM (5 g in each buttock)
#**Observe for loss of reflexes, respiratory depression
#**Must adjust dose in patients with renal failure
#*If seizures recur:
#**Consider alternative diagnosis
#**Consider other [[anticonvulsant]] drugs
#***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]]
#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>:
#**Severe [[renal failure]]
#**[[Pulmonary edema]]
#**[[Myasthenia gravis]]
#BP Control
#BP Control
##Lower to Sys 130-150, dia 80-100
#*Lower to Sys 130-150, dia 80-100
###Labetalol
#**[[Labetalol]]
####Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
#***Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
####Option 2: Initial 20mg; then IV infusion of 1-2mg/min
#***Option 2: Initial 20mg; then IV infusion of 1-2mg/min
###Hydralazine
#**[[Hydralazine]]
####5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
#Persistent seizure
#*See [[status epilepticus]]
#*Plan appropriately for delivery


===Prevention===
*The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. ([[Evidence Based Recommendation Levels| B recommendation]])
==Disposition==
==Disposition==
*Emergent OB/GYN consultation
*Admit, emergent OB/GYN consultation


==See Also==
==See Also==
*[[Post-Partum Emergencies]]
*[[Post-Partum Emergencies]]
*[[Preeclampsia]]
*[[Preeclampsia]]
*[https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/19sm02a170703EclampsiaCheck1.pdf?dmc=1&ts=20190908T1328374017 ACOG Eclampsia Checklist]
==References==
<references/>


==Source==
*Tintinalli
*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
*Uptodate
*Uptodate


[[Category:OB/GYN]]
[[Category:OBGYN]]

Latest revision as of 22:28, 1 October 2019

Background

  • Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
    • May occur sooner with gestational trophoblastic disease
  • Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures

Differential Diagnosis

Preeclampsia

Seizure

3rd Trimester/Postpartum Emergencies

Management

  1. Delivery
  2. Seizure treatment
  3. BP Control
    • Lower to Sys 130-150, dia 80-100
      • Labetalol
        • Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
        • Option 2: Initial 20mg; then IV infusion of 1-2mg/min
      • Hydralazine
        • 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
  4. Persistent seizure

Disposition

  • Admit, emergent OB/GYN consultation

See Also

References

  • EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
  • Uptodate